The St. Joseph Hospital (Orange, California) Nursing Research Blog will communicate the nursing research activities at SJO to staff. Communications may include, but are not restricted to, announcements of Nursing Grand Rounds, Nursing Journal Clubs, Nursing EBN classes, ongoing nursing research and relevant medical library announcements and news. Secondly, this blog will serve as an open discussion forum for nurses and librarians interested in evidenced based nursing.

Friday, August 28, 2009

Just came across this fascinating article ( at least to me): Learning from research on the information behaviour of healthcare professionals: a review of the literature 2004- 2008 with a focus on emotion. Fourie, Ina. Health Information & Libraries JournalVolume 2009 26(3):171 - 186. This study is a very detailed analysis of the scant literature on the role that "emotion" plays in health provider's information seeking behavior. Emotion goes way beyond what we might initially think and extends to include nine identified themes. Just a few of these 9 identified themes include: "difficulty in identifying and expressing information needs and information behavior", "uncertainty and anxiety", the role that personality and coping skills play and the role that self confidance and attitude play. The author even offers a detailed table with a large number of suggestions as to how Library and Information Science(LIS) professionals might impact or ameliorate the information seeking barriers of "emotional issues". One quote that really resonated with me from MacIntosh-Murrray and Choo in their article "Information behavior in the context of improving patient safety" Journal of the American Society for Information Science and technology 2005 56:1332-1345 "...front line staff are task driven, coping with heavy workloads that limit their attention to and recognition of potential information needs and knowledge gaps" However, a surrogate in an information-related role, an "information/change agent"-may intervene successfully with staff ..."What do you all think? any innovative ways in which librarians can better play this role as an information surrogate?

Wednesday, August 26, 2009

Please join us for the St. Joseph Hospital 5th Annual Evidence-Based Practice Conference, “Evidence Based Approaches to Infection Prevention and Management” on Friday, October 2 from 8-4:30pm at St. Joseph Center, Orange, Ca. This 8-hour course will include various speakers from St. Joseph Hospital as well as from local healthcare agencies.

Topics will include: Influenza, HealthCare Associated Infections, Current Legislation, Biofilm, Community Trends in TB and others.This annual conference has been one of our best attended classes of the year and will prove to be another interesting and educational event. Learn the latest and improve your clinical practice!Registration is NOW available for St. Joseph Hospital Employees through our new on-line registration through CareNet.

For those interested from outside St. Joseph Hospital, please call the Clinical Education Department for further information about registration at (714) 771-8000, extension 17345. Cost for the entire day is $75.00. Space is limited and early registration is recommended.

Monday, August 17, 2009

The July/August 2009 supplementary issue of Journal of NursingAdministration is devoted entirely to "The Evidence forMagnet® Status". Articles that look especially interesting include: "Workplace Empowerment and Magnet Hospital Characteristics as Predictors of Patient Safety Climate" and "Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes". Employees of St. Joseph Hospital, Orange and CHOC may access the full text of the articles via the library's website. Others should contact the medical library at your institution.

Wednesday, August 12, 2009

On August 3, 2009 the Journal of the American College of Cardiology published a paper reviewing the evidence of the benefits of fish oil or Omega-3 polyunsaturated fatty acids (PUFAs).

The findings support the use of fish oil for everyone- not just heart patients! The evidence supports that fish oil prevents as well as treats cardiovascular disease. Fish oil has been found to prevent heart failure as well as decrease hospitalization and death in both heart failure and post-MI patients. It has shown to reduce arrhythmias as primary and secondary prevention- particularly in atrial fibrillation (AF). Fish oil also helps to prevent atherosclerosis and there is data to suggest it helps in hyperlipidemia.

The optimal dose of fish oil- as measured by EPA/DHA is at least 500 mg per day for prevention and 800-1000mg per day for those with known heart disease. This can be accomplished with supplements or eating fatty fish such as salmon, tuna, mackerel, or sardines. Healthy persons would need 2 servings per week while heart patients would require 4 or 5 fish servings per week.

Further study is needed to determine optimal mix of EPA to DHA and mechanisms of action in arrhythmias, atherosclerosis and primary myocardial disease. The abstract of the paper is free at http://content.onlinejacc.org/cgi/content/abstract/54/7/585 and a synopsis of the article is available at the heart.org then go to heartwire( you must sign in for a free membership) to access the article dated 8/10/09.

Effectiveness of Topical Administration of Opioids in Palliative Care: A Systematic Review [Authors' Abstract].The discovery of peripheral opioid receptors has become the scientific basis for topical use of opioids in malignant and nonmalignant ulcers and oropharyngeal mucositis. This systematic review aimed to assess the quality of published literature and to examine whether topical opioids are effective in controlling pain in palliative care settings. After a systematic literature review, 19 studies (six randomized controlled trials [RCTs] and 13 case reports) met the inclusion criteria for the review. Eighteen studies favored topical opioids in pain relief, as evidenced by reductions in post-treatment pain scores, but time to onset and duration of analgesia varied widely. Because of the heterogeneity of the studies, meta-analysis was not possible. Despite clear clinical benefits described in small RCTs, there is a deficiency of higher-quality evidence on the role of topical opioids, and more robust primary studies are required to inform practice recommendations. N-of-1 trials should be encouraged for specific clinical circumstances.

The clinical problem of painful skin and mucosal lesions is a challenge in all settings, but particularly in palliative care where systemic opioids may not be sufficient for pain relief or where patients may resist systemic opioids due to unfavorable side effects. This systematic review used the Centre for Evidence-Based Medicine methods, and was done appropriately, although the last search for primary studies was done in August 2006 and the publication date is May 2009 (a long window of time for newer studies to have been published). Findings showed that topical opioids were used for both malignant and nonmalignant wounds as well as oropharyngeal mucositis. Applications for skin wounds were 1-6 times daily and every 2-3 hours for mouthwashes. Opioids were administered in a variety of carriers (e.g.., hydrogel). The primary finding was pain relief following use of topical opioids. Secondary findings indicated that 0.1% diamorphine (heroin) led to pain relief in one hour with duration between 24 and 48 hours, while topical morphine relieved pain immediately to 60 minutes after administration and lasted 2 to 45 hours in ulcers and one to four hours in mucositis.Scarce reports were found related to adverse effects. Primarily reported were local effects such as itching, burning, and discomfort. Possible administration problems existed with exudates and possible tolerance with prolonged usage.Due to the intrinsic difficulties with studies in palliative care patients (heterogeneity, low recruitment, high drop out rates), the authors recommended N of 1 trials. In N of 1 trials, a single subject receives a treatment or placebo in a randomly assigned order; data are collected on outcomes to determine effect in this one patient. For example, a palliative care patient with a wound might be set up to receive 6 days of treatment (3 days of a topical opioid/3 days of placebo; order determined in a random manner) with pain monitored carefully for severity, onset of pain relief, adverse effects etc.

Monday, August 03, 2009

Cochrane reviews are considered by most to be the Gold standard in evidence based medicine. This resource is updated every three months and now has nearly 20,000 voluntary reviewers. As such, the Cochrane systematic reviews have a well deserved global reputation. One of the newest reviews that is getting a lot of press is Treatment blood pressure targets for hypertension. This study is particularly important as so many guidelines are recommending even lower blood pressure targets. The summary in this review states: "Main results No trials comparing different systolic BP targets were found. Seven trials (22,089 subjects) comparing different diastolic BP targets were included. Despite a -4/-3 mmHg greater achieved reduction in systolic/diastolic BP, p<>Authors' conclusions .Treating patients to lower than standard BP targets, ≤140-160/90-100 mmHg, does not reduce mortality or morbidity. Because guidelines are recommending even lower targets for diabetes mellitus and chronic renal disease, we are currently conducting systematic reviews in those groups of patients. "